Patent Foramen Ovale

Patent Foramen Ovale

Patent foramen ovale (PFO) refers to the presence of a small flap or opening between the heart’s upper right and left chambers (atria). Before birth, everyone has this opening, known as a foramen ovale. In the majority of cases, this occurs after birth. Patent foramen ovale occurs when the flap continues to exist following birth. “Patent” means “open.”

Most individuals with PFO have no symptoms and do not require treatment. However, uncommon complications associated with the presence of PFO include stroke and mini-stroke.

A fetus does not use its lungs to obtain blood rich in oxygen. Instead, this blood is delivered via the umbilical cord from the placenta of the mother. A foramen ovale directs the oxygen-rich blood from a fetus’s right upper chamber (right atrium) to the left upper chamber (left atrium) (left atrium).

The blood then travels to the left side of the fetus’ heart and delivers oxygen to the brain.

After birth, the foramen ovale normally closes. This occurs when the infant begins breathing and blood begins to flow to the lungs to receive oxygen. This blood then enters the left side of the infant’s heart before being pumped throughout the remainder of their body.

Symptoms of Patent Foramen Ovale

The majority of people will not experience any signs or symptoms directly related to PFO. 
Among the possible PFO symptoms are:
  • Stroke
  • Transient ischemic attack (TIA) or mini-stroke that impairs your ability to move your arms or legs, and affects vital organs such as the brain, small intestine, large intestine (colon) or kidneys

Less common conditions people may experience include:

  • Heart attack (myocardial infarction)
  • Low blood oxygen levels (hypoxemia)
  • Platypnea-orthodeoxia (P-O) syndrome, which includes shortness of breath while upright along with low blood oxygen levels.

Causes of Patent Foramen Ovale

The causes of PFO are unknown. There are no known risk factors. It can be found along with other heart abnormalities such as atrial septal aneurysms or Chiari network.

Diagnosis of Patent Foramen Ovale

Your doctor will first inquire about your symptoms and conduct a physical examination. If your doctor suspects PFO, he or she may suggest the following tests:

The echocardiogram (also referred to as an echo) uses sound waves to create images of your heart’s chambers. A provider performs a transthoracic echocardiogram on your chest using a probe.
Transesophageal echocardiogram (TEE): Your healthcare provider positions a probe equipped with a miniature camera near your esophagus. TEE can depict PFO more clearly than a standard echocardiogram.
Transcranial Doppler (TCD) ultrasound: TCD ultrasound examines blood flow to and within the brain using sound waves. This examination can also detect a stroke caused by blood clots.
Your doctor may also recommend a bubble test in addition to an echo or TCD ultrasound. During a bubble test, a saltwater solution is injected into your vein. If your lungs do not filter out the bubbles and they travel through the hole to the left side of your heart, you may have PFO.

Treatment of Patent Foramen Ovale

The majority of people with patent foramen ovale will not require treatment. If you have a history or high risk of strokes or blood clots, however, your doctor may recommend treatment. Among the treatments for PFC are:

Aspirin and warfarin are examples of anticoagulant medications.
Your interventional cardiologist will use catheterization to close the flap (catheter). Your surgeon inserts the catheter into the large vein in your groin and guides it to your heart via the blood vessel. Then, a closure device is used to seal the flap. Catheterization is superior to surgery for treating PFO in patients under 60 years old, according to studies.
During heart surgery, the surgeon makes an incision and closes the flap with stitches. Surgical intervention may be suggested if catheterization is unsuccessful. Your surgeon may perform an open-heart procedure or a minimally invasive robotically assisted patent foramen ovale repair. They perform this operation through small chest incisions.